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In the United States, it is estimated that, by 2010,

> 2 million people will be afflicted with CKD.(3)

Anemia occurs early in the development of kidney disease and worsens with declining kidney function. anemia was present in 40% of CKD stage 3

patients, 5055% of stage 4 patients, and 80% of

the CKD stage 5 group.(5)

Kidney damage for > 3 months, structural or functional abnormalities of the kidney, with or without decreased GFR. GFR < 60 mL per minute per 1.73 m2 for three months or more, with or without kidney damage.(2)

Susceptibility factors Initiation factors Progression factors End-stage factors

Urine test : Urinalysis Twenty-four hour urine tests Glomerular filtration rate (GFR)

Blood test : Creatinine and urea (BUN) in the blood Electrolyte levels and acid-base balance Blood cell counts Other test : Ultrasound

The World Health Organization defines anemia as a hemoglobin concentration lower than 13.0 g/dL in men and postmenopausal women and lower than 12.0 g/dL in other women. Anemia is very common in patients with chronic kidney disease and probably causes many of its symptoms. In the third National Health and Nutrition Examination Survey (NHANES), the prevalence of anemia in stage 3 chronic kidney disease was 5.2%, rising to 44.1% in stage 4, and becoming almost universal in stage 5.

Blood loss Shortened red blood cell life span Vitamin deficiencies Uremic milieu EPO deficiency Iron deficiency Inflammation

Exogenous erythropoietic protein (ESAs therapy)

Iron supplementation

A reduction in mortality during the first 24

month after initiating hemodyalisis was noted in patients treated with erythropoietin in the predialysis phase of care.

Benefits of anemia correction in CKD that have been

reported in the literature include :

improved

sense

of

well-being,

quality

of

life,

neurocognitive function and work capacity.

Reduced need for packed red blood cell transfusions

Reduced allosensitization prior to renal transplantation

Reduced hospitalization

Anemia is very common in patients with chronic kidney disease and probably causes many of its symptoms

Deficient renal production of erythropoietin is the major cause of

anemia in chronic kidney disease, although iron deficiency also contributed significantly

ESAs should be given to achieve and maintain a target hemoglobin concentration of 11.0 to 12.0 g/dL. Patients should receive iron supplementation while on ESA therapy.

Anemia in CKD patients should be treated in order to achieve the benefits of increased exercise capacity, quality of life, cognitive and sexual function, as well as a reduction in transfusion requirements and hospitalizations.

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4.

5.

US Department of Health and Human Service. Anemia in Kidney Disease and Dialysis. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). September 9, 2010. Available at : http://kidney.niddk.nih.gov/kudiseases/pubs/anemia. Accessed on May 21, 2012 National Kidney Foundation. Chronic Kidney Disease. Available at : http://www.kidney.org/kidneydisease/aboutckd.cfm. p.1-16. Accessed on May 21, 2012 Xue JL, Ma JZ, Louis TA, Collins AJ. Forecast of the number of patients with end-stage renal disease in the United States to the year 2010. Journal of the American Society of Nephrology (JASN). p.2753-2758. June 4, 2001. Available at : http://jasn.asnjournals.org/content/12/12/2753.abstract. Accesed on May 21, 2012 Macdougall C, Walker R, Provenzano R. Corrects Anemia in Patients with Chronic Kidney Disease not on Dialysis: Results of a Randomized Clinical Trial. Clinical Journal of the American Society of Nephrology (CJASN). p.337-347. March 2008. Available at : http://cjasn.asnjournals.org/content/3/2/337.full . Accesed on May 21, 2012 Mucsi Istvan, Molnar MZ, Rosivall L. Anemia Management in Chronic Kidney Disease. Division of Nephrology Humber River Regional Hospital and Faculty of Medicine University of Toronto p.24-26. 2008 Available at : http://www.touchbriefings.com/pdf/3249/rosivall.pdf Accesed on May 28, 201

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US Department of Health and Human Service. The Kidneys and How They Work. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). March 23, 2012. Available at : http://kidney.niddk.nih.gov/Kudiseases/pubs/yourkidneys/#kidneys. Accesed on May 28, 2012 Function of Kidney. Available at: http://www.sglearnonline.com/function-of-kidney.html. Accessed on May 28, 2012. Kathuria Pranay. Chronic Kidney Disease. p.1-19. Available at : http://www.emedicinehealth.com/chronic_kidney_disease/article_em.h tm . Accesed on June 15, 2012 Nurko Saul. Anemia in Chronic Kidney Disease: Causes, diagnosis, treatment . Cleaveland Clinic Journal of Medicine. p.289-297. March, 2006. Available at : www.ccjm.org/content/73/3/289.short . Accesed on June 15, 2012 Perazella Mark . CKD series : Evaluation and Treatment of Anemia in Chronic Kidney Disease. Available at : http://hpboardreview.com/pdf/hp_jul03_chronic.pdf . Accesed on June 18, 2012 Hori WH, Vanrenterghem Y, Aljama P, Brunet P. OPTA: Optimal Treatment of Anaemia in Patients with Chronic Kidney Disease (CKD). Oxford Journal Nephrology Dialysis Transplantation. p.22. 2006. Available at : http://www.oxfordjournals.org/our_journals/ndt/about.html . Accesed on June 18, 2012